Key findings from the second SwazilandHIVIncidence Measurement Survey,SHIMS2, reveal impressive progress in confronting theHIVepidemic in the country. Results show a doubling in population viral load suppression since 2011 and a decrease by nearly half in the rate of newHIVinfections. The findings were released today at a press conference held by the Prime Ministers office in Mbabane, Swaziland and at the International Aids Society (IAS) 2017 Conference in Paris, France.

Because of the severeHIVepidemic in Swaziland, it was critical for us to implement a combinationHIVprevention package, scale upHIVcare and treatment services, and engage in ongoing measurement ofHIVincidence in order to assess the impact of these efforts, said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. The results of theSHIMS2survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.

The data come from one of the population-basedHIVimpact assessment (PHIA) surveys led by the Government of the Kingdom of Swaziland (GKoS) through the Ministry of Health (MOH) and Central Statistical Office (CSO). The survey (SHIMS2) was implemented byICAPat Columbia University and the US Centers for Disease Control and Prevention (CDC), with funding from the Presidents Emergency Plan forAIDSRelief (PEPFAR).

SHIMS2is the second national incidence survey to be conducted in Swaziland, following the 2011 survey (SHIMS1) among adults 18-49 years of age.

InSHIMS2, over 14,000 children and adults participated in this nationally representative survey by agreeing to be interviewed and providing a blood sample forHIVtesting.

Key SHIMS2 survey results include:

The annual rate of newHIVinfections (HIV incidence) among adults ages 15 years and older was 1.36 percent: 1.70 percent among females and 1.02 percent among males. Among adults 18-49 years,HIVincidence was 1.39 percent, nearly half of the priorHIVincidence rate in 2011 2.48 percent.

The percentage of the adult population living withHIV(HIV prevalence) was 27.0 percent: 32.5 percent among females and 20.4 percent among males. TheHIVprevalence among adults 18-49 years was 30.5 percent, similar to the 2011HIVprevalence of 32.1 percent.

The percentage of allHIV-positive adults with viral load suppression (VLS), an indication that the infection is under control, was 73.1 percent: 76.0 percent among females and 67.6 percent among males.VLSwas estimated using all people living withHIV(PLHIV) as a denominator, regardless of knowing theirHIVstatus or use of antiretroviral drugs. Among allHIV+ adults aged 18-49 years, twice as many hadVLSinSHIMS2as compared to SHIMS1 (71.3 percent compared to 34.8 percent in 2011).

The percentage of allHIV-positive adults who knew theirHIVstatus was 84.7%; of these individuals, 87.4% reported current use of antiretroviral treatment and, among those reporting treatment, 91.9 percent hadVLS.

The progress represented by the findings is attributed to the expansion ofHIVtesting in the country as well as a substantial increase in the number ofHIV-positive individuals on antiretroviral drugs from 2011 to 2016. This is combined with otherHIVcontrol interventions expanded in the country.

These remarkable findings from Swaziland add to the evidence base that we are beginning to control theHIVepidemic in several high-burden countries, said Ambassador Deborah L. Birx, M.D., U.S. GlobalAIDSCoordinator and Special Representative for Global Health Diplomacy. They both demonstrate our extraordinary progress in ensuring that olderHIV-positive adults are on life-saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women withHIVservices.

An amazing array of partnerships lasting over a decade from collaboration within and between governments to coordination across international organizations and implementers have brought us to an incredible level of success in the work onHIVandAIDSin Swaziland, said Lisa J. Peterson, US Ambassador to Swaziland. These partnerships are about people bringing their time and talents together to effect change. Thanks to these joint efforts, theSHIMS2data show that many more people will have the opportunity to share their own time and talents with their families and communities. It is especially important that we sustain and strengthen our collective engagement with Swazilands youth to ensure that we achieve anAIDS-free generation.

The partnership with the Swazi Ministry of Health was fundamental to the success of the survey, said Shannon Hader, MD,MPH, director of the CDCs Division of GlobalHIV& TB. As weve seen in other countries, thePHIAfindings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.

The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting theHIVepidemic, said Wafaa El-Sadr, MD,MPH,MPA, director ofICAP. It is a demonstration that all the efforts put into the scale-up ofHIVprevention, care and treatment services have borne fruit.ICAPis honored to have played a role in helping to support this successful scale-up.

Each Population-basedHIVImpact Assessment PHIA survey provides a report card on how each country is doing in responding to its epidemic as well as a blueprint for future response, said Jessica Justman, MD, ICAPs senior technical director and principal investigator of all of ICAPsPHIAprojects, including SHIMS1 andSHIMS2. Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. TheSHIMS2results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.

Other collaborating governmental entities in Swaziland included the Health Research Unit, Swaziland Health Laboratory Services (SHLS), Swaziland NationalAIDSProgram (SNAP), Health Promotion Unit, Health Management Information System, Environmental Health Department, and National Emergency Response Council onHIV/AIDS (NERCHA).

Additional details onSHIMS2are available in the summary sheet released by the Swaziland Ministry of Health and the websites for the Ministry of Healthwww.gov.sz,CDC/PEPFARwww.cdc.govandwww.pepfar.gov, andICAPsPHIAProject:phia.icap.columbia.edu.

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Swaziland Survey Shows Impressive Progress in Confronting the HIV Epidemic - Reliefweb